Alfie Evans and the Shocking UK Gosport Independent Panel Report

The Baby Alfie Evans’s case this year shocked the world but now we learn his forced death against his parents’ wishes follows a legal and healthcare nightmare in the UK.

Some of us expressed concerns years ago about the UK’s “Liverpool Care Pathway” developed in the 1990s to improve care of the dying by applying “the high standard of palliative care prevalent in hospices to other clinical settings”.  But the “Liverpool Care Pathway” went horribly wrong and in 2009, the UK Daily Mail published an article “Euthanasia by the back door: Hospitals ‘death pathway’ is open to error” with cases of non-dying patients considered “not worth saving” who died from the “combination of dehydration and powerful painkillers”, explaining that:

“Under the Liverpool Care Pathway, doctors can withdraw fluids and drugs from patients if they are deemed close to death. Many are then put on continuous sedation so they die free of pain.

But sedation can often mask signs of improvement, meaning doctors may be closing the door on people who would otherwise live for months.”

In 2013, the British Journal of General Practice published “The Liverpool Care Pathway for the dying: what went wrong?” . The authors acknowledged the problems that led an independent review to call for an end to the Liverpool Care Pathway but concluded that:

“(a)vacuum left by the abolition of the LCP makes a return to the ‘bad old days’ of poor or non-existent communication about dying a real possibility: we would argue that the response to poor use should be right use, not non-use” and  called for “increased funding and training in palliative care and suggest that skills in end-of-life care should become a required competency for all health care professionals.” (Emphasis added)

THE GOSPORT INDEPENDENT PANEL REPORT

More details of this scandal have just now surfaced in a report on the Gosport War Memorial Hospital  where patients were often admitted for rehabilitation or respite care. The report concludes that at least 450 patients had their lives “shortened” by denial of food and water along with powerful painkillers between 1989 and 2000. It details cases and concerns and ultimately acknowledges the families’ years-long pleas for the truth. Here is one excerpt:

“Those (nurses) who raise concerns about the conduct and practice of colleagues are now widely known as ‘whistle-blowers’. To put it into context, it is generally agreed that the NHS (National Health Service) has not been good at protecting people who take such a difficult step; as the documents make clear, the events of 1991 were no exception. Nor should the consequences for whistle-blowers be underestimated: these commonly included disciplinary action and undermining of professional credibility.

“The documents show that, following a complaint to the Trust in 1998 and the police investigation, it should have become clear to local NHS organisations that there was a serious problem with services at the hospital. Although the successive police investigations undoubtedly complicated the NHS response, it is nevertheless remarkable that at no stage was there a public admission of failure or any public apology. Nor was there a proportionate clinical investigation into what had happened. On the contrary, the documents show numerous instances of defensiveness and denial – to families, to the public and the media, and to health service and other organisations.” (Emphasis added)

CONCLUSION

Will charges now be brought against those involved in the Gosport War Memorial Hospital euthanasia deaths? Who knows? The Independent Panel only concluded that:

“With this Report and an online archive of documentation, the Panel has completed its Terms of Reference. The Panel now calls upon the Secretary of State for Health and Social Care and the relevant investigative authorities to recognise the significance of what is revealed by the documentation in this Report and to act accordingly.

But just as important is the question “Has health care now improved?”

Unfortunately, the answer may be no.

As the UK Telegraph reported in 2015 in the article “New NHS (National Health Service) death guidelines ‘worse than Liverpool Care Pathway’”, the Liverpool Care Pathway was supposedly phased out in 2014 in favor of the National Institute of Health and Care Excellence (NICE) guidelines. but families were still reporting poor end of life care, including denial of food and water.

And now, unlike that Liverpool Care Pathway horrors that were hidden for so long, we had the very public case of Baby Alfie Evans this year where courts enforced the doctors’ decision to shorten his life by removing his ventilator, refused his family’s requests to transfer him or take him home and even take away his feedings when he continued to breathe for days after the ventilator was removed.

Apparently, the death culture is apparently very hard to kill in the UK and, as we are finding, also in the US.

“Fatal Flaws”: A Must-See Film

With the American Medical Association considering changing its’ long-standing opposition to physician-assisted suicide despite the recommendations of its’ ethics committee and the California assisted suicide law declared unconstitutional now reinstated pending appeal, assisted suicide/euthanasia groups like Compassion and Choices (the well-funded former Hemlock Society) are ramping up efforts nationwide to legalize assisted suicide.

Along with major media outlets overwhelmingly supporting their efforts and a recent Gallup poll showing  that the “Majority of Americans (73%) Remain Supportive of Euthanasia”, how do we fight against this and educate the public?

One excellent answer can be found in the recently released 80 minute film “Fatal Flaws”.

“Fatal Flaws” features filmmaker Kevin Dunn who spent three years traveling throughout Europe and North American asking the question “should we be giving doctors the right in law to end the life of others by euthanasia or assisted suicide?”

In the film, Mr. Dunn respectfully interviews people and experts on both sides of the issues and the candid testimonies are powerful and moving. I have viewed the film myself and I believe that showings of this film to senior citizen groups, pro-life groups, churches and clergy, medical professionals, etc. would go a long way in educating the public, many of whom are supportive  or unsure of where they stand.

The film was produced in association with The Euthanasia Prevention Coalition. For information on purchasing the  “Fatal Flaws” film and/or the accompanying pamphlets, please go the Euthanasia Prevention Coalition “Fatal Flaws” site.

There will be a preview viewing of the film at the National Right to Life Convention June 29, 2018.

On a personal note: I am speaking at the NRL convention myself on the Alfie Evans’ case June 30, 2018 and I would love to meet those of you attending the convention.

 

 

Don’t Write Off The Elderly

Late last year, my 95 year old friend I will call “Melissa” fell and fractured her hip which is especially serious at her age. In one study of people over 65 who fractured a hip, up to 50% died in 6 months with the highest mortality rates found in people over 90 years old.

In Melissa’s case, she also had long-term chronic congestive heart failure when she fell in her bathroom at home. She underwent successful surgery and was sent to a rehab facility where she developed a blood clot that went to her lungs. After successful treatment of that complication, she later developed a life-threatening pneumonia after returning to the rehab facility. She had difficulty breathing even with 100% oxygen by mask and 911 was called. I was with her when the ambulance arrived and I followed it to the hospital.

In the Emergency Room, the doctor asked her son and I about how aggressive to be if her heart or breathing worsened. I said “Ask her!” and the doctor was stunned when she vehemently said “Yes!”, even after he explained the potential problems with cardiopulmonary resuscitation and ventilators. My friend has a durable power of attorney naming her daughter as her health decision maker but the doctor wrongly assumed my friend was not able to speak for herself and that Melissa’s son and I were her decision makers. Thanks to our smartphones, Melissa’s daughter and I were in constant phone contact during that time.

After a few weeks in the hospital, Melissa astonished the doctors by recovering with antibiotics and a temporary BiPap (a face mask machine to support her breathing) until the antibiotics took hold. Then, after another short stint in a facility, my friend was finally able to go home with outpatient rehab and help from family and friends.

Going home was Melissa’s first goal.

This week, she accomplished the second of her goals: returning to Friday Mass and breakfast at Chick-Fil-A for her weekly outing with friends again. Her last goal is to celebrate at her 96th birthday party in August and none of us would bet against her achieving that also.

Elder Bias

In a society that seems to almost venerate youth and material success, those of us who are older can be made to feel useless and even a burden.

That can be fatal.

For example and just this month, 104 year old Australian scientist David Goodall who had no terminal illness traveled to Switzerland for physician-assisted suicide and to actively promote it.

According to USA Today, he said that:

My abilities and eyesight are declining, and I no longer want to live this way...I hope something positive will come out of my story and that other countries will adopt a more liberal view of assisted suicide.”

Sadly, he also added that he “had no pressure from his family to change his mind.” (Emphasis added)

David Goodall was a renowned biologist who produced more than 100 research papers and earned three doctorates when:

“In 2016, at 102, the university ordered him to leave his office, calling him a safety risk to himself. Goodall challenged the decision, which was reversed after an outpouring of public support.

Earlier this year, however, Goodall fell while at home alone in his one-bedroom apartment and remained on the floor for two days until he was found by his cleaner, according to The New Daily.

Afterward, Goodall said he was considered incapable of looking after himself. Moreover, most of his friends were dead.”

Philip Nitschke, director of Exit International, a right-to-die organization in Australia called Goodall’s “story of elective, rational suicide by the elderly is an important one.” (Emphasis added)

CONCLUSION

What a sad, depressing story Mr. Goodall’s story is compared to Melissa’s!

This should be a wake-up call to the rest of us not only about the frightening expansion and promotion of physician-assisted suicide but also about how all of us need to recognize the value, wisdom and even inspiration of older people.

We must also recognize that we all need help at some point in our lives. We are totally dependent on others when we are born and many of us need at least some help near the end of our lives. But when we truly care for each other, both the helper and the person being helped are enriched to live their best lives.

 

 

My Book Review on “Nurses and Midwives in Nazi Germany: The ‘Euthanasia Programs’”

“Nurses and Midwives in Nazi Germany-The ‘Euthanasia Programs’”
Edited by Susan Benedict and Linda Shields
Routledge Studies in Modern European History. London: Routledge 2014

My book review (abstract) was just published in the Linacre Quarterly journal. Here are some excerpts from my review with all emphasis added only for this blog.

In my nursing education during the 1960s, the Nazi euthanasia program was covered during a class but mainly as a ghastly aberration that was unthinkable today with our now strong ethical principles. As students, we were shocked and horrified by the revelation that nurses were integral to Nazi killing programs. We had little knowledge of the mechanisms that existed to encourage nurses to kill those patients whose lives were deemed “not worth living.”

Unfortunately, it is difficult these days to find information about nurses during the Nazi regime, even on the American Nurses Association website. Thus, the editors of this book do nurses and the public a great service by examining the little-known but crucial role of nurses in the Nazi euthanasia programs. Knowing this history is more important than ever as efforts to legalize assisted suicide and euthanasia continue to grow.

The authors explain the history, education, propaganda, and pressures that led so many nurses to participate in the killing of hundreds of thousands of helpless men, women, and children in the 1930s and 1940s; they also propose a model for teaching nursing ethics using the Nazi euthanasia program to encourage nursing students to examine ethical principles and their own values as a nurse in today’s health-care system.

……

The authors start with the rise of the influential eugenics movement in the early twentieth century in countries like the United States where the American Eugenics Society even held conferences on eugenics, such as the 1937 one which included the topic “The Relation of Eugenics to the Field of Nursing.” Eventually, the US eugenics movement fell out of favor after the Nazi euthanasia programs were discovered in World War II.

Even prior to World War II, German professional nursing publications discussed eugenics as “providing a scientific basis for the positive eugenics promoting reproduction among the healthy (often of northern European descent) middle to upper classes and negative eugenics encouraging limited reproduction and forced sterilization of the ‘unfit’ (who were often poor, uneducated, and more recent immigrants) as reasonable”.  Eugenic language was most prevalent in public health and psychiatric nursing texts and in discussions of poverty, immigrants, cleanliness, and social problems.

The editors also point to the influence on Adolf Hitler of the 1920 book titled Approval of the Extermination of Worthless Human Lives by Germans Karl Binding, a jurist, and Alfred Hoche, a psychiatrist. Binding and Hoche noted that there were no legal arguments preventing legalizing the killing of those whose lives were considered not worth living. (Emphasis added)

There was extensive propaganda aimed at increasing the acceptance of euthanasia by the public and health-care providers. Only a few months after Hitler seized power, the first law, affecting people diagnosed with psychiatric conditions, was passed. It mandated sterilization for people with hereditary disorders including alcoholism and epilepsy. Propaganda emphasized wastefulness of providing health care to the chronically mentally ill and the hereditary nature of undesirable physical, mental, and social traits.

Hitler did not propose the systematic killing of psychiatric patients during peacetime because he anticipated the opposition of the churches and the German people. The beginning of World War II muted moral objections and distracted the populace with concerns of conserving resources for the war effort and was the start of state-sponsored euthanasia. The first documented killing occurred in 1939 when Hitler granted the euthanasia request of a father whose son was born blind, missing a leg and part of an arm and who “seemed to be an idiot” .

In 1939, the German Ministry of Justice proposed two new clauses:

1.“Whoever is suffering from an incurable or terminal illness which is a major burden to himself or others can request mercy killing by a doctor, provided it is his express wish and has the approval of a specially empowered doctor.”

2. “The life of a person who, because of incurable mental illness, requires permanent institutionalization and is not able to sustain an independent existence may be prematurely terminated by medical measures in a painless and covert manner” . (Emphasis added)

The program started targeting those in asylums and the disabled in nursing homes for death by lethal gas, starvation, drugs, and neglect. The Jewish population was especially targeted regardless of health.

………

 

In 1933, Adolf Bartels, the deputy leader of the Reich’s medical profession, provided a blueprint of the future of nursing under the Nazis. He emphasized that German nurses in social and medical service had to meet standards in the new Reich that were very different from before. The new Reich not only wanted to look after the sick and weak but also wanted to secure a healthy development of all Germans “if their inherited biological predisposition allows for it” (p. 38). Above all, the new state wanted to secure and promote a genetically sound, valuable race, and, in contrast to the past, “not to expend an exaggerated effort on the care of genetically or racially inferior people”. (Emphasis added)

As a Nazi politician stated, “a nurse is the one who should carry out the will of the State in the health education of the people”. It was not necessary for the majority of nurses to become ardent supporters of the Nazi regime for them to do the will of the Reich. One source noted that the majority of nurses who participated in a secret euthanasia program known as T4 tried to remain good nurses; an estimated 10 percent or fewer were enthusiastic supporters of Nazi practice. But, as in other areas of public life, the Reich absorbed professional nursing organizations, leaving the nursing profession with no means of expressing opposing or dissenting views as well as no organizational support for refusing to participate. (Emphasis added)

……

 

Using midwives, the Reich took various measures both to prevent those regarded as having a “hereditary disease” or who were “racially inferior” from reproducing while increasing the birth rate of those considered valuable and healthy. Thus, the traditional midwife focus on the mother and child was changed to focus on the nation as a whole.

Midwives could initiate proceedings for forced sterilization, and it was now a duty for midwives to report to public health officers “deformed” births and small children with disabilities before their third birthday. Reports received from doctors and midwives were reviewed by medical examiners, and based solely on the reports, the examiners decided whether the child was to be killed or spared.

Parents with such children were told about institutions for children who needed special care that were being established through the country. They were persuaded to admit these children and were assured that the children would receive the best possible care. Parents could refuse but had to sign forms stating their responsibility to supervise and care for their children. The identified children in these institutions were killed by starvation or lethal injection. Parents were told that their children had died from natural causes.

……..

The world was riveted by the 1945 Hadamar trial, the first mass atrocity trial after the Nazi regime was defeated in World War II. This trial came before the infamous Nuremburg trials that included doctors. Hadamar was covered extensively by American media but ignored by the American Journal of Nursing even though nurses were charged.

The trial involved one of the largest and most important killing centers, Hadamar Psychiatric Hospital, one of the six institutions in Germany designated for killing the mentally ill. In 1943, a ward (called an “educational home”) was set up for mixed-race children with Jewish heritage within Hadamar. Completely healthy children were killed with lethal injections. The actual numbers are not known because employees were required to take an oath of secrecy. It is estimated that more than 13,000 patients were killed in 1941 and 1942, even before the ward was set up.

 

In the first Hadamar trial, Head Nurse Irmgard Huber was tried with six others for killing over 400 men, women, and children. Nurse Huber was charged with “obtaining the lethal drugs, being present when some of the fatal injections were given, and being present when the false death certificates were made out”. Two male nurses were charged with administering the lethal injections. All pleaded not guilty. Their defense was that they were powerless and had inadequate knowledge to judge the morality of their actions. All denied accountability. (Emphasis added)

Trial testimony confirmed that the nurses prepared patients for their deaths, directed the entire nursing staff of the institution, and were present at the daily conferences where the falsified death certificates were completed. Duties to patients were limited to so-called kindnesses that consisted of bringing small gifts to pediatric patients and taking care to prevent patients from knowing that they would soon be killed. Head Nurse Huber insisted that she wished to render a last service to these patients and did not want to do them any harm and that she had a clear conscience.

…….

The second Hadamar trial in 1947 did not receive the same attention as the first. Twenty-five members of the Hadamar staff were charged. At this trial, Head Nurse Huber was charged with killing 15,000 German mental patients. All but one of the defendants were found guilty and served sentences ranging from two and a half to five years. The one nurse found not guilty claimed she had feigned pregnancy in order to achieve release from the killing center. (Emphasis added)

In the end, Head Nurse Huber was released from prison in 1952; the others by 1954.

………

The book presents a model used for two innovative teaching programs about this subject, one in Israel and one in Australia, perhaps the most important contribution of this book. The editors believe that the Nazi era should be taught to students, “highlighting the danger of failing to see each individual as a valuable member of human society. And while the heart of nursing and midwifery continues to be care and caring practices, it is fundamental for students to confront this history to develop insights into the causes and social constructs that enabled nurses and midwives to distort the goal of nursing practice and theory to harm and murder patients.”

The results of these programs and the responses by students appear encouraging. The editors hope that by raising these issues, students will be forced to confront their own values and beliefs, sometimes an intensely uncomfortable experience. They also believe students who are exposed to this “dark element of nursing and midwifery history” will be better prepared to face pressure or to report and oppose violations of the trust that is central to any relationship between nurses and patients

 

CONCLUSION

Decades after the Nazi atrocities, we are seeing a resurgence of the same “life unworthy of life” justification that drove Nazi eugenics. We see how this perspective increasingly approves the deliberate termination of some lives as “merciful” and “humane.” There is an emerging, shocking consensus that we can—or perhaps even should—choose to have our own lives terminated when our lives are considered not worth living either by ourselves or by others if we cannot speak for ourselves.

The authors of this book make it clear: we all need to know and understand the past in order not to repeat it. Hopefully, it is not too late to turn the tide of history back toward respect for all life.

 

 

Whatever Happened to Common Sense at the End of Life?

In 2007, I wrote an article titled “Whatever Happened to Common Sense at the End of Life?” for Voices magazine. I wrote about real life situations that people and their families faced along with the principles involved. I am reprising that article here in response to the many questions I receive about dealing with such difficult situations.

Unfortunately since I wrote this article, the situations people and their families face have become worse: More states have legalized assisted suicide and have expanded the definition of “terminal”,  more parents of babies with disabilities are fighting for their  right to treatment , voluntary stopping of eating and drinking (VSED) is promoted as a legal way to kill oneself, etc.

I have and will continue to write on these newer issues but the basic principles are still valid.

Whatever Happened to Common Sense at the End of Life?

Withdrawal of treatment, “living wills”, terminal sedation, assisted suicide, organ donation, etc. Currently, it’s virtually impossible to escape all the death talk in the media and elsewhere. For example, if you are admitted to a hospital for almost any reason, you or your relatives will be asked if you have or would like information about documents formalizing your “end-of-life” choices.

But despite all the hype, not every situation involving end-of- life issues has to involve wrestling with big ethical dilemmas. Many times, there are relatively simple considerations or strategies that actually used to be commonly employed until the introduction of the so-called “right to die”. Accurate information, common sense and a good understanding of ethical principles can cut through the “right-to-die” fog and make a person’s last stage of life as good as possible both for the person and his or her family.

Here are just four examples:

Prolonging Death or Providing Comfort?

I once cared for Mary (all names have been changed), an older woman who was near death with cancer. Her loving family took her to the doctor when she became confused and severely short of breath. An x-ray showed a fluid buildup near her lungs. The doctor inserted a long needle, aspirated the fluid and Mary immediately improved. However, the family was still worried. They asked me what they should do if the fluid built up again because they were afraid that this would prolong her death. I told them that the primary question now was comfort. If, for example, fluid did slowly build up again but Mary was comfortable, it could be burdensome to aspirate the fluid. However, if Mary did develop severe breathing problems that could not be controlled by medication, they might want to consider another aspiration since the goal was to make Mary as comfortable as possible during the short time she had left.

“Why, that’s just common sense!” the daughter exclaimed. Exactly!

Mary soon peacefully died at home with her family, never needing another medical intervention.

Families often suffer undue fear about prolonging death when a family member is dying and this can spoil what can be one of the most meaningful times in life.

After almost 40 years as a nurse, I have found that barring murder or other such situations, people generally die when they are ready to die even regardless of medical interventions. When death is imminent, the big priority should be comfort rather than whether a person might live a few hours or days longer.

What if an Elderly Person Doesn’t Want Treatment?

One of my friends was very worried about his elderly grandmother whose health seemed to be declining. She ate very little and said she was ready to die. Efforts to improve grandma’s nutrition didn’t work and she refused a feeding tube. My friend was finally able to persuade her to at least try a small feeding tube inserted through her nose.

Within a short time, there was a dramatic improvement in grandma’s mood and physical functioning. According to my friend, she was back to where she was 10 years before and the feeding tube was removed. (She lived comfortably several more years.)

Too often, doctors and even families assume that an elderly person who doesn’t feel well is just dying of old age without exploring possibilities such as depression, poor nutrition, loneliness, treatable physical problems, etc. Sometimes the answer may be as simple as antidepressants or better nutrition. At the very least, it is worthwhile to explore the options. If an elderly person is truly dying, he or she will die but the family will have the comfort of knowing that they did what they could do.

For example, in a similar situation, another friend was caring for her frail, elderly mother with chronic lung and heart problems. Ann’s mom agreed to try a feeding tube but after a short initial improvement, her mom started going downhill again. Fluid began to build up and the feedings were stopped. Ann’s mom was given what little food and fluid she wanted and she eventually died of natural causes.

Particularly in the frail elderly, it can be difficult to determine whether or not a person is truly dying. And while we are never required to accept treatment that is medically futile or excessively burdensome to us, sometimes this can be hard to determine. Far too many times, feeding tubes and other interventions are automatically assumed to be futile and/or burdensome or reasonable options are presented as just a yes or no choice. But there is another alternative that is often ignored: trying an intervention with the option of stopping it if it truly is futile or burdensome.

There are no guarantees in life or death but even finding out that something doesn’t work can be a step forward.

Shouldn’t We Be Allowed to Die?

Years ago, I received a phone call from a distraught fellow nurse living in California. Her sister, Rose, was comatose from complications of diabetes and had been in an intensive care unit for three days. Now the doctors were telling the family that Rose’s organs were failing and that she had no chance to survive. The doctors recommended that the ventilator and other treatments be stopped so that she could be “allowed to die”. My nurse friend was uncomfortable with this even though the rest of the family was ready to go along with the doctors.

As I told her, back when I was a new nurse in the late 1960s, we would sometimes see patients in the intensive care unit who seemed hopeless and we would speak to families about Do Not Resuscitate (DNR) orders. However, the one thing we didn’t do was to quickly recommend withdrawal of treatment. We gave people the gift of time and only recommended withdrawing treatment that clearly was not helping the person. Some patients did indeed eventually die but we were surprised and humbled when an unexpected number of these “hopeless” patients went on to recover, sometimes completely.

About six weeks after the initial phone call, my friend called back to tell me that the family decided not to withdraw treatment as the doctors recommended and that her sister not only defied the doctors’ prediction of certain death but was now back at work. I asked her what the doctors had to say about all this and she said the doctors termed Rose’s case “a miracle”.

“In other words” she noted wryly, “these docs unfortunately didn’t learn a thing.”

Cases like this are usually not miracles. Virtually every doctor and nurse has seen at least one surprising recovery and almost every day brings a new media report about yet another unexpected recovery. However when such considerations as cost, a poor prognosis or low quality of life intersect with the “right to die”, people can literally be forced to die prematurely. When doctors and ethicists decide to play God — even with good intentions — that arrogance can be fatal.

Isn’t It Compassionate to Support a Person’s Right to Die?

When I first met Frank, I was puzzled. Frank was a terminally ill man who I was supposed to see for pain control but he didn’t seem to be in any physical pain at all. I talked to Frank’s wife Joan who tearfully confided to me that Frank was cleaning his gun collection when he asked her if she would still be able to live in their home if, in his words, “anything happened”.

Joan knew he was talking about shooting himself and even though she was horrified, she said she knew the right thing to say: “I will support any decision you make”. However, she later panicked and called the doctor to ask about pain control and that’s when I came in.

When I suggested to Joan that Frank’s real question might not be about their home but rather about whether his slow death might be too hard on both of them, she was stunned and said that this never occurred to her. She loved Frank and she wanted to care for him until the end.

Frank and Joan then finally had an open and long overdue discussion about their sorrow and fears. When I last saw them, they were holding hands and smiling. Frank died peacefully — and naturally — a few weeks later with his wife at his side.

As a situation like this shows, political correctness can actually be lethal itself. Unfortunately, the public is given the message that “tolerance” is a paramount value. From abortion to euthanasia, we are constantly told that opposition to these practices is callous and inhumane. We are told that we cannot impose our own narrow morality on people who do not agree.

Sadly, in the case of assisted suicide/euthanasia, it’s this tolerance that really can make the life or death difference. I’ve worked with some suicidal people over the years and I have found that ambivalence over whether or not to kill oneself is virtually routine. For example, one terminally ill woman I cared for said that she would take an overdose when she left the hospital. She didn’t seem sad or depressed and was actually quite animated and smiling. As she put it, she was just tired of being tired and feared that the future “was just all downhill”.

However, when we talked about her feelings, the ramifications of her decision and what help was available, she slowly changed her mind. But when she excitedly told her friends about her new decision to live, these friends tracked me down to give me a real tongue-lashing about not supporting this woman’s original choice.

The ultimate irony of the push to spread legalized assisted suicide beyond Oregon’s terrible law is that at the same time we naturally see suicide as a tragedy to be prevented, we are pressed to accept that suicide is a compassionate choice for the terminally ill and even others.

A Time to Live, a Time to Die

When I worked as a hospice nurse years ago, our guiding principle was that we neither prolonged nor hastened dying. I totally supported this and I felt great satisfaction helping my patients and their relatives live as fully as possible until natural death. We nurses not only made sure that people were as physically comfortable as possible, we also helped with spiritual, emotional and practical concerns.

Unfortunately, the “right-to-die” enthusiasts have had way too much success in trying to convince both medical personnel and the public that choice in dying is really the ultimate principle. However, trying to micromanage death by such measures as withdrawal of basic treatment, terminal sedation, lethal overdoses, etc. profoundly changes the medical system, even for people who may recover or who may live with disabilities.

The “right to die” movement is really about despair rather than hope or true justice. People deserve the best in health care and that includes the right to both excellent care and a natural lifespan.

It’s just common sense.

From “Choice” To “No Choice”-Lessons from the Baby Alfie Evans Case

Defending the UK High Court’s order allowing Alder Hay Children’s Hospital to withdraw life support from Baby Alfie Evans and refusing to even allow his parents to take him home, Dr. Ranj Singh of the UK National Health Service was quoted: “This is not the killing of a child – this is redirecting care to make them more comfortable.

Although this callous statement suggests an economic motive, I believe the real problem is a fundamental shift in legal and medical ethics that started in the US in 1976 with the Karen Quinlan case.

Karen was a 21 year old woman whose parents wanted to remove her ventilator after she did not wake up after losing consciousness after a party. The doctors disagreed but the California Supreme Court upheld parents’ decision by stating:

“No compelling interest of the state could compel Karen to endure the unendurable, only to vegetate a few measurable months with no realistic possibility of returning to any semblance of cognitive or sapient state,” then-Chief Justice Richard Hughes wrote. (Emphasis added)

Ironically, Karen did not stop breathing and lived 9 more years with a feeding tube and basic care. But Karen’s case set the stage for the so-called “right to die” movement, “living wills” with removal of feedings and eventually the current assisted suicide/euthanasia movement.

Unfortunately, Baby Alfie and his parents are just the latest casualties of an emerging legal/medical/popular mindset that some people are better off dead. To make matters worse, Baby Alfie’s case-like the similar Baby Charlie Gard case  in the UK last year-are perhaps intended to become examples to discourage other parents (or families) from challenging doctors, hospitals and courts on mandatory withdrawal of treatment decisions.

WHAT HAPPENED TO BABY ALFIE AND COULD THIS HAPPEN HERE IN THE US?

Baby Alfie Evans was born in the UK on May 9, 2016 and apparently healthy. His parents became concerned when he missed the developmental milestones that most babies achieve in their first 7 months and started making “jerking, seizure-life movements”.

In December 2016, he caught a chest infection that caused seizures and was placed on a ventilator at Alder Hey Children’s Hospital. Despite the doctors’ dire predictions, Alfie started breathing on his own but caught another chest infection and seizures and went back on a ventilator.

Without having a definitive diagnosis after a year and Baby Alfie in what his doctors called a “semi-vegetative” state, the hospital and doctors wanted to remove his ventilator but Alfie’s parents fought back.

The hospital took the case to the British High Court, stating that “further treatment” for Alfie was “not in his best interests” as well as “unkind and inhumane”.

After many failed court appeals by the parents and even help from Pope Francis and an Italian hospital ready to take the baby, the hospital remained intractable and Alfie was not even allowed to go home with his parents. The ventilator was removed but, contrary to the doctors’ predictions, Alfie continued to breathe on his own for five more days before finally dying.

I watched the tragedy of Baby Alfie from afar with a lot of alarm as well as personal sadness.

I first became aware of medical discrimination against babies with mental disabilities in 1982 with the Baby Doe case. Baby Doe was born with Down Syndrome and a correctable congenital defect in his throat that makes eating food orally impossible but his parents refused surgery on the advice of the obstetrician but against the recommendations of two other doctors who advised immediate surgery. The case went to court but the judge ruled in favor of his parents. The parents also refused all offers of adoption. Baby Doe died from starvation and dehydration while lawyers were still appealing his case. Tragically, Baby Doe did not even receive simple intravenous fluids to keep him alive until his appeals were finished. Many of us who spoke out about Baby Doe’s right to treatment were accused of being “mean” to his parents.

When my daughter Karen was born just after Baby Doe died and also with Down Syndrome as well as a treatable heart defect, I was offered the “choice” of refusing heart surgery for her and “letting” her die. However, even after I insisted on the surgery, I found out that one doctor made her a Do Not Resuscitate behind my back and I was told by others-even other health care professionals like myself-things like “People like you shouldn’t be saddled with a child like that!”

I became so fearful that at one point I slept on the floor under my daughter’s crib during an overnight hospitalization for a test.

It was devastating when Karen died from sudden complications of pneumonia at 5 ½ months but I will never regret fighting for her right to be treated the same as other children with her heart defect.

With Baby Simon Crosier who was born with Trisomy 18 and a heart defect in 2010, his parents begged for help when Simon started deteriorating without knowing that the hospital had made their baby a Do Not Resuscitate and was being given only “comfort feeds” due to a secret futility policy. They had to helplessly watch as Simon died in their arms. The later Simon’s Law bill they helped write to prevent other outrageous secret futility guidelines in hospitals continues to sit in a Missouri legislative committee but hopefully it will get to the House floor this session. (Simon’s Law was passed in Kansas in 2017.)

PARENTAL DECISION-MAKING

The usual standard for parental decision-making in the US has been:

“Medical caretakers have an ethical and legal duty to advocate for the best interests of the child when parental decisions are potentially dangerous to the child’s health, imprudent, neglectful, or abusive. As a general rule, medical caretakers and others should challenge parental decisions when those decisions place the child at significant risk of serious harm. ” (Emphasis added)

But, after Baby Doe starved to death, medical groups fought the proposed Baby Doe Regulations intended to protect such children with disabilities as too restrictive. For example, the American Medical Association endorsed the quality of life standard prior to the Baby Doe case :

“In the making of decisions for the treatment of seriously deformed newborns or persons who are severely deteriorated victims of injury, illness, or advanced age, quality of life is a factor to be considered in determining what is best for the individual.

In caring for defective infants the advice and judgment of the physician should be readily available, but the decision as to whether to treat a severely defective infant and exert maximal efforts to sustain life should be the choice of the parents.” (Emphasis added)

But at a pediatric ethics conference in 1994, I was shocked by a workshop where the  focus was on how to convince parents to refuse or withdraw treatment from seriously disabled or dying children. One speaker/lawyer was even applauded when he suggested that parents who refused to withdraw treatment like feeding tubes from their “vegetative” children were being “cruel” and even “abusive” by not “allowing” their children to die. He also said that judges would be most likely to side with the doctors and/or ethics committee if such cases went to court.

Over the years and unknown to most of the public, many ethicists still refuse to concede this “choice” of a right to continue treatment and instead have developed a new theory that doctors cannot be forced to provide “inappropriate” or “futile” care to patients of any age. This theory evolved into “futile care” policies at hospitals in Houston, Des Moines, California and other areas. Even Catholic hospitals have been involved.

And now, as Baby Simon’s parents and I have unfortunately found, such decisions are sometimes made without even notifying us. This must change with not only legislation like Simon’s Law but also a change of attitude towards these little ones.

CONCLUSION

While there are situations where a family or patient might unreasonably demand truly medically futile or unduly burdensome treatment, the decision to deliberately end the life of a person because he or she is deemed to have little or no “quality of life” should never be made.

The terrible ordeal that Baby Alfie and his parents went through sparked tremendous outrage around the world, especially the callous treatment of his obviously loving parents.

This was inhuman, not “humane” and we must continue the fight to demand truly ethical, caring and nondiscriminatory healthcare, especially for the youngest among us.

 

Conscientious Objection and the Duty to Refer

When the Trump administration announced a new department of Conscience and Religious Freedom, the pushback from abortion and assisted suicide proponents like Planned Parenthood and Compassion and Choices was immediate and accompanied by apocalyptic predictions of harm to patients.

Now the term “conscientious objection” is increasingly being used rather than “conscience rights” when it comes to health care professionals. I believe this is not accidental. The term “conscience rights” is a powerful and accepted term about individual rights while “conscientious objection” is associated with the traditional definition of  “A person who refuses to serve in the military due to religious or strong philosophical views against war or killing” and who “may be required to perform some nonviolent work like driving an ambulance.” (Emphasis added)

Nevertheless, in a March 30, 2018 Medscape (password protected) article titled “Should Clinicians With Conscientious Objections Be Protected?”, well-known ethicist Arthur L. Caplan, PhD criticizes the new Conscience and Religious Freedom Division as an expensive “overreaction” that can be mediated by allowing health care professionals to refuse to provide a legal act (like abortion or assisted suicide in certain areas NV) but requiring them “to tell patients where they can go and how they can go about getting it.”

This echoes last year’s New England Journal of Medicine article “Physicians, Not Conscripts — Conscientious Objection in Health Care” by Dr. Ezekiel Emanuel (one of the architects of Obamacare) and Ronit Y. Stahl, PhD. who insist that medical professionals “cannot completely absent themselves from providing these services” and are still required to convey “accurate information” and provide “timely referrals to ensure patients receive care.”

The authors even state that:

“Health care professionals who are unwilling to accept these limits have two choices: select an area of medicine, such as radiology, that will not put them in situations that conflict with their personal morality or, if there is no such area, leave the profession. “ (Emphasis added)

Their rationale for this extreme position is that “the patient comes first, which means the patient’s conscience and autonomy receive priority over those of the physician.”  (Emphasis added)

However, this could now conflict with the recently amended federal Affordable Care Act (aka Obamacare) that states:

 “No qualified health plan offered through an Exchange may discriminate against any individual health care provider or health care facility because of its unwillingness to provide, pay for, provide coverage of, or refer for abortions.”

and

“The Federal Government, and any State or local government or health care provider that receives Federal financial assistance under this Act (or under an amendment made by this Act) or any health plan created under this Act (or under an amendment made by this Act), may not subject an individual or institutional health care entity to discrimination on the basis that the entity does not provide any health care item or service furnished for the purpose of causing, or for the purpose of assisting in causing, the death of any individual, such as by assisted suicide, euthanasia, or mercy killing.” (All emphasis added)

THE DUTY TO “CONVEY ACCURATE INFORMATION” AND “REFER”

Ironically, do groups like Planned Parenthood and Compassion & Choices really want to require a medical professional opposed to abortion and/or assisted suicide to convey accurate information?

First of all, medical referrals require a measure of trust. For example, no doctor or nurse would knowingly refer a patient to another doctor or organization that he/ she considers incompetent or unethical or for a procedure the medical professional considers harmful to the patient. When a patient asks for procedures like abortion or assisted suicide, the medical professional should be free to refer the patient to support services like crisis pregnancy centers, etc. or to an ethical palliative care specialist, mental health expert, etc. The medical professional should also be free to convey accurate information regarding abortion such as  how abortions are performed, potential physical and emotional complications, fetal development, etc.  With assisted suicide, the medical professional should be free to discuss such issues as the potential complications of a lethal overdose, the potential effects on family and friends, the criminal/ civil immunity of the assisted suicide doctor if the assisted suicide goes awry, etc.

Medical professionals should also have the right to be honest and tell patients if they personally don’t know any doctor or organization that they would recommend to provide a referral for abortion or assisted suicide.

Patients, especially those in distress, need a well-informed medical professional who really listens to their concerns and responds with facts and helpful options rather than one who just hands out a “politically correct” referral.

CONCLUSION

The so-called duty to perform/participate in a life-ending procedure or refer for one is not really about conscience rights but rather another way to extinguish resistance to abortion and assisted suicide, normalize such procedures into standard medical practice and discourage/bully ethical health care professionals into leaving or never entering the medical professions.

Those of us who believe in medical ethics as, first and foremost, doing no harm to patients must actively fight this for the sake of our professions and for the safety of the public that puts their lives in our hands.

If we don’t speak up for our medical professions and our patients, who will?

 

Assassins, Not Doctors

Last year, both Hawaii and New Zealand physician-assisted suicide bills were defeated but, much like zombies, both bills were changed and resurrected for 2018.

As I wrote in a  previous blog about Hawaii’s bill, there are concerted efforts not only to pass but also expand assisted suicide laws. This bill is currently awaiting either passage or defeat in the Hawaii legislature’s Senate.

Recently, I submitted testimony on the “End of Life Choice Bill” to legalize physician-assisted suicide in New Zealand. Currently, the bill is being considered in the Select Committee.

The New Zealand bill is different from Hawaii’s in significant ways. Here are some of the differences, with emphasis added:

-It adds “grievous and irremediable medical condition in an advanced state of irreversible decline in capability”  to the usual condition of terminal illness.

-It give patients the option of 4 ways to kill themselves or be killed, including lethal injections:

(i) ingestion, triggered by the person:
(ii) intravenous delivery, triggered by the person:
(iii) ingestion through a tube:
(iv) injection

-“The attending medical practitioner must be available to the person until the person dies; or arrange for another medical practitioner to be available to the person until the person dies” by being “in the same room”  or “in close proximity to the person”.

-Conscience rights: If doctors refuse to provide the lethal overdose, they must refer to a SCENZ group established by the Director General to “make and maintain a list of medical practitioners who are willing to act for the purposes of this Act as—replacement medical practitioners: independent medical practitioners”,  list of pharmacists, and “to prepare standards of care; and to advise on the required medical and legal procedures; and to provide practical assistance, if assistance is requested.”

-The assisted suicide death (whose official cause is listed “as if assisted dying had not been provided”) must be reported within 14 days and sent to registrar who must send the report to a Review committee consisting of a medical ethicist and a medical practitioner who practices in area of end of life care and another medical practitioner. The Review committee has these functions: “to consider reports sent to it”, “to report about its satisfaction or otherwise with the cases reported” and “to recommend actions that the registrar may take to follow up with which the review committee was not satisfied.”

-Regular reports will be issued every five years after the first to be done 3 years after the law is implemented. These reports go to the minister and Parliament.

WHY DOES NEW ZEALAND “NEED” PHYSICIAN-ASSISTED SUICIDE?

While citing “strong public support” and “compassion” as motivating this physician-assisted suicide law in the explanatory note at the beginning of the New Zealand bill, the authors also cite cases in New Zealand where “the courts are treating the family members who have assisted their loved ones to die at their request with increasing leniency and compassion.” (Emphasis added)

This, they say “demonstrates further issues with the current state of our law, under which it is becoming permissible, in effect, for family members to assist loved ones to take their own lives. This is clearly less ideal, less clear, and considerably more risky than a regulated process in which medical practitioners can, in limited circumstances, assist those who are suffering.” (Emphasis added)

CONCLUSION

This last statement shows how lethally corrupting assisted suicide is: New Zealand must legalize physician-assisted suicide to spare family members while requiring participating doctors to even administer lethal injections at the sick person’s request and stay until he or she dies?

This turn participating doctors into assassins, not medical professionals.

Very few people enter the health care professions ready to kill some patients or help them kill themselves and dispassionately watch them die. But if physician-assisted suicide becomes law in New Zealand, health care professionals and even society itself will be forced to adjust to the new reality.

As I wrote in my testimony on New Zealand’s bill:

“Do assisted suicide supporters really expect doctors and nurses to be able to assist the suicide of one patient, then go on to care for a similar patient who wants to live, without this having an effect on their ethics or empathy? Do they realize that this can reduce the second patient’s will-to-live request to a mere personal whim – perhaps, ultimately, one that society will see as selfish and too costly? How does this serve optimal health care, let alone the integrity of doctors and nurses who have to face the fact that they personally helped other human beings kill themselves? (Emphasis added)

Conclusion

Medically assisted suicide is a dangerous proposition that has proven to be impossible to strictly limit, corrupts the essential element of trust in the health care system and makes suicide more attractive to vulnerable people as a way to solve life’s problems.”

 

Legal Safeguards, Burdensome Obstacles and Conscience Rights

After I wrote last week’s blog “The New Federal Conscience and Religious Freedom Division” , I was surprised by this criticism: “arguing conscience can make doctors (and others) look whiney, as opposed to heroic” and give assisted suicide supporters “an easy platform to describe them as selfish and out of touch ideologues who want to make their parents suffer.” But this comment did make me think.

Actually, I felt horror, intense sadness and fear when, as I wrote in the blog, I was “threatened with termination (after the fact) for refusing to participate in an unethical health care decision years ago.” I was trying to save my patient from being deliberately terminated with an overdose of morphine that neither he nor his family requested but I found no support in the “chain of command” at my hospital. I could not pass this patient to another nurse so I basically stopped the morphine drip myself, technically following the order “titrate morphine for comfort, no limit”.

Especially as the sole support of three children with no family support, I feared losing my job but I could not participate in good conscience for my patient’s sake. I did not feel either heroic or whiney.

Ironically, a later autopsy requested by the family showed no lethal condition or brain injury as suspected when the patient had a crisis after routine surgery.

I’ve known other doctors, nurses and therapists who have similarly put their jobs on the line for the real reason for conscience rights: protection of patients. We are a thinning white line in the face of expanding demands for deliberate death as a civil right while our US and other countries’ professional organizations are changing or considering changing their positions against medically assisted suicide and euthanasia.

If we who refuse to terminate our patients are harassed or eliminated from our professions and future potential students discouraged from choosing such a profession, patients will be denied the choice of such medical professionals and a final barrier will be broken in the lethal flood to follow.

WHEN “LEGAL SAFEGUARDS” BECOME “BURDENSOME OBSTACLES”

Already there are impatient calls to expand medically assisted suicide and euthanasia.

Thaddeus Pope, JD, PhD, the influential Director of the Health Law Institute and Professor of Law at the Mitchell Hamline School of Law in Saint Paul, Minnesota and writer of the Medical Futility Blog, wrote an article last December titled “Medical Aid in Dying: When Legal Safeguards Become Burdensome Obstacles” for the American Society of Clinical Oncology Post. (According to ASCO, it “has taken no official position on medical aid in dying”.)

Mr. Pope notes the “uniformity and similarity” of the six current medically assisted suicide statutes but brings up four so-called “safeguards” affecting the “next-generation issues: the justifiability of prevailing eligibility criteria and procedural requirements” that will allegedly need to be addressed. (Emphasis added)

The first is “Expanding From Adults to Mature Minors” which Mr. Pope characterizes as “unduly restrictive” in part because “Many states already allow terminally ill mature minors to withhold or withdraw life-sustaining treatment”. (Emphasis added)

Mr. Pope’s second issue is “Expanding From Contemporaneous Capacity to Advance Directives”, stating that “All six statutes require that the patient concurrently have both a terminal illness and decision-making capacity. But this dual mandate excludes many patients who have no other exit options” such as those with “advanced dementia”. (Emphasis added)

The third issue he cites is “Expanding From Terminal Illness to ‘Reasonably Predictable’” because:

“(T)his rigid time frame excludes patients with grievous and irremediable conditions that cause suffering intolerable to the individual. Some medical conditions may cause individuals to irreversibly decline and suffer for a long period before dying. Instead of demanding a strict temporal relationship between a medical condition and death, these statutes might be more flexible and instead require that death be ‘reasonably predictable’.” (Emphasis added)

Mr. Pope’s final issue is “Expanding From Self-Ingestion to Physician Administration”:

“First, it excludes patients who lose the ability to self-administer before they otherwise become eligible. Second, self-ingestion is associated with complications. For example, around 3% of these patients had difficulty ingesting or regurgitated the medication. Other patients regained consciousness after ingestion.” (Emphasis added)

And, as in most of the previous issues, Mr. Pope approvingly cites the rapidly expanding assisted suicide situation in Canada:

“Canadian patients avoid all these problems (with self-ingestion), because physicians usually administer the medication. As a result, only 5 of more than 2,000 Canadian patients who used medical aid in dying self-ingested the lethal medication.” (Emphasis added)

Ironically, there is one so-called “safeguard” that Mr. Pope would like to see tightened:

“that the prescribing or consulting physician refer the patient “for a mental health specialist assessment” if “there are -indications of a mental disorder.” Yet prescribing and consulting physicians have referred only 5% of medical aid in patients who are dying. Leading experts argue that this rate is probably too low relative to the expected rate of impaired judgment. Others are “surprised by how rarely the prescribing or consulting physicians refer patients for a psychiatric consultation.” (Emphasis added)

This discrimination in suicide assessment is not acceptable for any suicidal person-except now, of course, for a person requesting medically assisted suicide.

CONCLUSION

Without a strong resistance movement, these proposals are only just the next step in the death agenda. So far, much of the public, government officials and medical professionals have been shielded from the real truth by euphemisms and false reassurances from assisted suicide supporters, a mostly sympathetic mainstream media and often spineless professional and health care organizations. We all must educate ourselves to speak out before it is too late.

Swedish Citizen Unmasks a Main Physician-assisted Suicide Propaganda Point

Oregon, the first US state to legalize physician-assisted suicide, is routinely promoted by advocates as having the model law for assisted suicide. Now the debate has come to Sweden.

The Swedish National Council of Medical Ethics, an advisory board to the Swedish government and parliament, published a November 20, 2017 report, Assisted Death: A Knowledge Compilation” (an English translation is coming) “to promote a more fact-based debate on assisted dying” and states that the Council “does not take a stand on assisted dying in the report”.

However, Fabian Stahle, a Swedish private citizen who read the report, found a problem.

In his article “Oregon Health Authority Reveals Hidden Problems with the Oregon Assisted Suicide Model” , he notes that:

“As a basis for their reassurance of no slippery slope in the Oregon model, the authors of the Swedish report note that there is one question that is ‘the crucial issue’: is anyone with a non-terminal, chronic disease granted medical assisted death?” (Emphasis in original)

But Mr. Stahle notes that the report says elsewhere that the six-month limit on expected survival time applies, “if no treatment is given to slow down the course of the disease” (Emphasis in original)  and thus “might complicate the the whole idea that the law only applied to the ‘untreatable’ sick where nothing could be expected to extend life beyond six months”.

So Mr. Stahle says he did his own investigation by contacting the Oregon Health Authority himself.  Craig New, Research Analyst with the Oregon Health Authority  replied and told him that:

“…your interpretation is correct: The question is: should the disease be allowed to take its course, absent further treatment, is the patient likely to die within six months” (Emphasis added)

Fabian Stahle went further by asking if the doctor suggests to a eligible patient a treatment that possibly could prolong life or transform a terminal illness to a chronic illness or even cure the disease but the patient refuses, would that patient still be eligible for physician-assisted suicide.

He gave the example of a patient with a chronic disease like diabetes who refuses life-sustaining medication/treatment and becomes likely to die within 6 months and asked if that person would be eligible for assisted suicide.

Oregon’s Mr. New answered yes and that if the patient does not want treatment, that would also be their choice-along with the choice for assisted suicide.

As Fabian Stahle observes, this “allows a sanctioned path to suicide, aided by a physician, for anyone with a chronic illness who is likely to die within six months if they chose to stop treatment.” (Emphasis in original)

Fabian Stahle then asked about patients with a chronic disease whose health insurance company is not willing to pay for the treatment/medication.

Oregon’s Mr. New responded that:

“I think you could also argue that even if the treatment/medication could actually cure the disease, and the patient cannot pay for the treatment, then the disease remains incurable.” (Emphasis added)

And thus the patient is considered eligible for assisted suicide under Oregon’s law. This is especially outrageous.

THE BOTTOM LINE

Unfortunately, much of the public just accepts the Compassion and Choices propaganda that physician-assisted suicide is a safe “choice” with strict regulations for terminally and incurably ill people who are going to die soon anyway. Unfortunately, a mostly sympathetic mainstream media concurs and portrays assisted suicide as a “humane” last resort for extreme cases.

But now, Fabian Stahle, a Swedish private citizen, has done what few people do today even with such a life and death issue: He actually investigated the topic and contacted the Oregon Health Authority to clarify what “terminal” and “incurable” really legally means in Oregon’s “model” law.

Of course, there are many other problems with physician-assisted laws but Mr. Stahle focused on the one cited by the Swedish National Council of Medical Ethics as ‘the crucial issue’: is anyone with a non-terminal, chronic disease granted medical assisted death?”

Mr. Stahle is right to question this. The latest Oregon report on their assisted suicide law shows a range of diseases from cancer to undefined “other illnesses” as well as 43 people whose “ingestion status” of the prescribed overdose is unknown and obviously not followed up to see if or when they died.

Having written medical news analysis articles in the past for a national newspaper, I am appalled by the routine lack of investigative interest in life or death issues like assisted suicide from today’s mainstream media. The public needs and deserves better.

I wish Fabian Stahle was eligible for a Pulitzer Prize.